Letter: Neurosurgery Residency in the COVID-19 Era: Experiences and Insights From Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.

To the Editor:

At Thomas Jefferson University, a 1000-bed quaternary care hospital in Philadelphia, Pennsylvania, our neurosurgical service has cared for numerous patients testing positive for the novel coronavirus and also presenting with neurosurgical conditions.

The institution has created a university-wide tiered system of classifying cases based on urgency and implemented strict policies governing visitation to the hospital, and has taken decisions on the management of risk of exposure and utilization of personal protective equipment (PPE).

NEUROSURGERY RESIDENT ROLE IN THE HOSPITAL

Neurosurgery residents have a ubiquitous role in the hospital and are often first responders. Therefore, it is of utmost importance that neurosurgery residents have 24/7 access to adequate PPE. Since neurosurgeons are often near the head, it would be prudent to follow the same precautions as our anesthesia colleagues. Based on the current recommendations, the Department of Neurosurgery at Thomas Jefferson University Hospital has been given access to powered air-purifying respirators (PAPRs).

NEUROSURGERY RESIDENT EDUCATION AND TEAM MORALE

While in-person conferences have been formally canceled in order to comply with social distancing criteria, we have found a way to come together, despite being separated, using the many internet-based resources that facilitate virtual group interactions.

Residents are not immune to the psychological effects of the COVID-19 pandemic. The suspension of all elective surgeries has drastically changed the daily schedule of many residents, who now find themselves with more free and unstructured time.

Furthermore, the health and safety of the neurosurgery residents is the top priority of our department at Jefferson. The program leadership has fought for the residents to secure adequate PPE to allow residents to respond safely and promptly to any COVID + neurosurgical emergencies.

To ensure coverage, the Chief Residents have devised a new call schedule with 2 teams to minimize exposures and mandated that residents who are not working stay home.

This pandemic offers a tremendous opportunity for residents to grow and discover a professional voice and identity, which is most influenced during residency training.

REDISTRIBUTION OF RESIDENTS IN A PANDEMIC SURGE

Neurosurgery residents are inherently facile in stressful situations, particularly in the intensive care unit (ICU) setting. Therefore, neurosurgery residents are working alongside those of general surgery to be part of a “Line Service” to place central and arterial lines in all COVID patients throughout the ICUs in the hospital. While planning for the critical care and acute inpatient needs of patients, we realize that we cannot make our plans in a vacuum—every department and clinical unit is interdependent in some way and has to unite in the fight against COVID-19.

Disclosures

The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.